News Category: Endemic countries

 

A child is vaccinated during a nationwide vaccination campaign in Jabuary 2022. Seven national and one sub national campaigns have taken place since 15 August last year. © WHO/Afghanistan
A child is vaccinated during a nationwide vaccination campaign in Jabuary 2022. Seven national and one sub national campaigns have taken place since 15 August last year. © WHO/Afghanistan

Wild poliovirus transmission in Afghanistan is currently at its lowest level in history. Fifty six children were paralysed by wild polio in 2020. In 2021, the number fell to four. This year to date, only one child has been paralysed, giving the country an extraordinary opportunity to end polio.

The resumption of nationwide polio vaccination campaigns targeting 9.9 million children has been a critical step. Since 2018, local-level bans on polio vaccination activities in some districts controlled by the Taliban had significantly reduced the programme’s ability to vaccinate every child across the country. With access to the entire country following the August transition, seven nationwide vaccination campaigns took place between November 2021 and June 2022, and a sub national campaign targeting 6.7 million children in 28 provinces took place in July. Of the 3.6 million children who had been inaccessible to the programme, 2.6 million were reached during the November, December and January campaigns. With improved reach to previously inaccessible children throughout the February to July campaigns, the number children has been reduced to 0.7 million. Further campaigns are planned for the remainder of the year.

With Afghanistan and Pakistan sharing one epidemiological block, the two countries continue to coordinate cross border activities. December and May’s campaigns were synchronized with Pakistan’s national campaigns, focusing on high risk populations including nomadic groups, seasonal workers and communities straddling both borders.

Improved access also had a significant impact on polio surveillance activities. Afghanistan’s surveillance indicators remained above global standards throughout the transition. With access to all districts since August, the quality of activities has improved significantly including early case detection and reporting.

In June, the first review of the polio surveillance system in six years took place with WHO hosting a team of technical experts including epidemiologists and virologists. A small team visited in 2016 but insecurity and lack of access to much of the country limited the visitors’ movements to Kabul, Herat, Kandahar, Jalalabad, Mazar-e-sharif and Kunduz. This year, the 16-strong team visited 76 districts across 25 of the country’s 34 provinces. The review determined the likelihood of undetected poliovirus transmission in Afghanistan to be low. Recommendations, including upscaling surveillance in the country’s south and south east, are being implemented.

With more than twenty years on the ground in Afghanistan, the polio programme continues to leverage its extensive operational capacity to deliver better health outcomes for all Afghans. In the face of an unprecedented humanitarian crisis, in addition to day-to-day polio activities, polio staff continue to regularly monitor the functionality of health facilities across the country as well as support ongoing vaccination campaigns including measles and COVID 19. WHO’s polio team in the southeast were among the first responders following the devastating earthquake in Paktika and Khost provinces in June. In addition to providing critical health care, the team’s experience working among local communities provided the foundations of an assessment tool that mapped affected communities and ensured accurate data guided a focused response in the immediate aftermath.

Although the number of children paralysed by polio has reduced significantly in Afghanistan, the threat is far from gone and the programme faces significant challenges. While access has improved across the country, accessing every child though house to house vaccination remains a challenge in some areas leaving immunity gaps and, with them, children at risk.

On 24 February, eight polio workers were killed in targeted attacks in the country’s north, not the first time polio workers had come under attack in the course of their life saving work. Four of those killed were women. Female polio workers play a critical role in the programme, building community trust and reaching all children.

The sharp rise in the number of wild polio cases in Pakistan is a cause for concern, and the detection of one case each in Malawi and Mozambique is a reminder of the continued risks of poliovirus and the urgencyrequired to permanently interrupt transmission in both Afghanistan and Pakistan.

While the polio programme has made important progress in the last 12 months, sustaining those gains with high quality campaigns that vaccinate all children and build enough immunity to end circulation of the virus for good is critical. A polio free Afghanistan is within reach – but there is still a long way to go.

Emergency health centres provide the most urgent medical support to families © WHO
Emergency health centres provide the most urgent medical support to families © WHO

When disaster strikes, co-ordination is key. Within hours of the 5.9 magnitude earthquake striking the communities of Afghanistan’s South East in the early morning of 22 June, WHO’s polio team was on the ground joining forces with UN agencies and NGOs to ensure an effective and coordinated relief effort.

As dawn broke across the provinces of Paktika and Khost, and the extent of the devastation became evident, polio teams worked across both provinces to establish communications and share reports of the length and breadth of the destruction.

The team’s invaluable experience and local knowledge gained from more than two decades working among local communities in both Paktika and Khost provided the foundations of an assessment tool to map communities and assess the number and extent of casualties as well as the destruction to homes and buildings. This ensured accurate data guided a focused response in the immediate aftermath including the rapid construction of tents for shelter as well as housing ad hoc health camps.

Helping clear rubble following the devastating earthquake © WHO
Helping clear rubble following the devastating earthquake © WHO

In the districts of Giyan, Geru and Barmal in Paktika, polio teams assisted in attending the injured, providing trauma care and dressing wounds. One team member was despatched to Spera district in neighbouring Khost province to assist with trauma care.

Polio teams turned a helping hand wherever needed including digging for survivors, building tents, unpacking trucks and distributing shipments of WHO emergency and surgical kits, medical supplies and equipment, and the heartbreaking task of preparing and assisting in transporting the dead for burial.

With the very real risk of increased communicable diseases in the wake of any natural disaster, polio staff drew on the polio surveillance system to strengthen post-earthquake surveillance for acute watery diarrhea, measles, tetanus and COVID 19.

Emergency provision of trauma care. © WHO
Emergency provision of trauma care. © WHO

More than 1,000 people died in the quake and nearly 3,000 were injured; homes buildings and livelihoods have been destroyed. The polio team will continue to work as part of WHO Afghanistan’s earthquake response including providing trauma care, physical rehabilitation and disability assistance.

The earthquake struck five days before the start of the fifth nationwide polio vaccination campaign for 2022. The campaign was postponed for one week in Paktika province and in Spera district of Khost province and will begin on 4 July.

Children show their inked fingers - a sign they have been vaccinated against polio. © WHO/Afghanistan
Children show their inked fingers – a sign they have been vaccinated against polio. © WHO/Afghanistan

Leaders at this week’s G7 Head of State meeting in Germany and last week’s Commonwealth Heads of Government meeting in Rwanda renewed global commitment to polio eradication.  In their official Communiqué, the Leaders of the Group of Seven (G7) vowed to ‘continue our support for polio eradication through the Global Polio Eradication Initiative’, while the Commonwealth Heads of Government, in their joint Communiqué on ‘Delivering a Common Future’, urged the continued intensified effort to eradicate polio, even amid other pressing health and development issues.  These calls and commitments follow similar engagements made at previous global political fora this year, notably the recently-held G7 Development and Health Ministers meeting, and the World Health Assembly.

Global partners of the eradication effort, notably led by Rotary International and Rotarians around the world, are working with the public sector to ensure political commitments are fully operationalized.

In April 2022, GPEI partners, led by WHO Director-General, launched the ‘Investment Case for Polio Eradication’, the sister document to the Polio Eradication Strategy 2022-2026, which lays out the economic and humanitarian rationale for investing in a polio-free world, as well as the broader benefits of polio eradication.

In October 2022, Germany will generously co-host a global pledging moment, giving the international development community and polio-affected countries the opportunity to publicly re-commit to this effort, including to support a stronger and sustainably-funded WHO, so that the organization can maintain its capacity to support countries in achieving and sustaining polio eradication, and continue to benefit broader public health efforts, including support for pandemic preparedness and response.

GENEVA, 26 April 2022

Today, the Global Polio Eradication Initiative (GPEI) announced that it is seeking new commitments to fund its 2022-2026 Strategy at a virtual event to launch its investment case. The strategy, if fully funded, will see the vaccination of 370 million children annually for the next five years and the continuation of global surveillance activities for polio and other diseases in 50 countries.

During the virtual launch, the Government of Germany, which holds the G7 presidency in 2022, announced that the country will co-host the pledging moment for the GPEI Strategy during the 2022 World Health Summit in October.

“A strong and fully funded polio programme will benefit health systems around the world. That is why it is so crucial that all stakeholders now commit to ensuring that the new eradication strategy can be implemented in full,” said Niels Annen, Parliamentary State Secretary to the Federal Minister for Economic Cooperation and Development, Germany. “The polio pledging moment at the World Health Summit this October is a critical opportunity for donors and partners to reiterate their support for a polio-free world. We can only succeed if we make polio eradication our shared priority.”

Wild poliovirus cases are at a historic low and the disease is endemic in just Pakistan and Afghanistan, presenting a unique opportunity to interrupt transmission. However, recent developments, due in part to impacts of the COVID-19 pandemic, underscore the fragility of this progress. In February 2022, Malawi confirmed its first case of wild polio in three decades and the first on the African continent since 2016, linked to virus originating in Pakistan, and in April 2022 Pakistan recorded its first wild polio case since January 2021. Meanwhile, outbreaks of cVDPV, variants of the poliovirus that can emerge in under-immunized communities, were recently detected in Israel and Ukraine and circulate in several countries in Africa and Asia.

The investment case outlines new modelling that shows achieving eradication could save an estimated US $33.1 billion this century, compared to the price of controlling polio outbreaks. At the launch event, GPEI leaders and polio-affected countries urged renewed political and financial support to end polio and protect children and future generations from the paralysis it causes.

“Despite enormous progress, polio still paralyses far too many children around the world – and even one child is too many,” said UNICEF Executive Director Catherine Russell.  “We simply cannot allow another child to suffer from this devastating disease – not when we know how to prevent it. Not when we are so close. We must do whatever it takes to finish the fight – and achieve a polio-free world for every child.”

“The re-emergence of polio in Malawi after three decades was a tragic reminder that until polio is wiped off the face of the earth, it can spread globally and harm children anywhere. I urge all countries to unite behind the Global Polio Eradication Initiative and ensure it has the support and resources it needs to end polio for everyone everywhere,” said Hon. Khumbize Kandodo Chiponda MP, Minister of Health, Malawi.

The new eradication strategy centres on integrating polio activities with other essential health programs in affected countries, better reaching children in the highest risk communities who have never been vaccinated, andstrengthening engagement with local leaders and influencers to build trust and vaccine acceptance.

“The children of Pakistan and Afghanistan deserve to live a life free of an incurable, paralyzing disease. With continued global support, we can make polio a disease of the past,” said Dr Shahzad Baig, National Coordinator, Pakistan Polio Eradication Programme. “The polio programme is also working to increase overall health equity in the highest-risk communities by addressing area needs holistically, including by strengthening routine immunization, improving health facilities, and organizing health camps.”

The investment case outlines how support for eradication efforts will enable essential health services in under-served communities and strengthen the world’s defences against future health threats.

Since 2020, GPEI infrastructure and staff have provided critical support to governments as they respond to the COVID-19 pandemic, including by promoting COVID-safe practices, leveraging polio surveillance and lab networks to detect the virus, and assisting COVID-19 vaccination efforts through health worker trainings, community mobilization, data management and other activities.

“The global effort to consign polio to the history books will not only help to spare future generations from this devastating disease, but serve to strengthen health systems and health security,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

Additional quotes from the GPEI Investment Case:

“We have the knowledge and tools to wipe polio off the face of the earth. GPEI needs the resources to take us the last mile to eradicating this awful disease. Investing in GPEI will also help us detect and respond to other health emergencies. We can’t waver now. Let’s all take this opportunity to fully support GPEI, and create a world in which no child is paralyzed by polio ever again,” said Bill Gates, Co-chair, Bill & Melinda Gates Foundation.

“An investment in polio eradication goes further than fighting one disease. It is the ultimate investment in both equity and sustainability – it is for everyone and forever. An important component of GPEI’s Strategy focuses on integrating the planning and coordination of polio activities and essential health services to reach zero-dose children who have never been immunized with routine vaccines, therefore contributing to the goals of the Immunization Agenda 2030.” said Seth Berkley, Chief Executive Officer, Gavi, the Vaccine Alliance.

“Twenty million people are walking today because of polio vaccination, and we have learned, improved and innovated along the way. We are stronger and more resilient as we enter the last lap of this marathon to protect all future generations of the world’s children from polio. Please join us; with our will and our collective resources, we can seize the unprecedented opportunity to cross the finish line that lies before us,” said Mike McGovern, Chair, International PolioPlus Committee, Rotary International.

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Investment Case 2022-2026

Media contacts:

Oliver Rosenbauer
Communications Officer, World Health Organization
Email: rosenbauero@who.int
Tel: +41 79 500 6536

Ben Winkel
Communications Director, Global Health Strategies
Email: bwinkel@globalhealthstrategies.com
Tel: +1 323 382 2290

Sabrina Sidhu
UNICEF New York
Email: ssidhu@unicef.org
Tel: +19174761537

April 2022 – Convening this month in Geneva, Switzerland, the Strategic Advisory Group of Experts on immunization (SAGE), the global advisory body to the World Health Organization (WHO) on all things immunization, urged concerted action to finish wild polioviruses once and for all.

The group, reviewing the global wild poliovirus epidemiology, highlighted the unique opportunity, given current record low levels of this strain. At the same time, it noted the continuing risks, highlighted in particular by detection of wild poliovirus in Malawi in February, linked to wild poliovirus originating in Pakistan.

On circulating vaccine-derived poliovirus (cVDPV) outbreaks, SAGE expressed concern at continuing transmission, in particular in Nigeria which now accounts for close to 90% of all global cVDPV type 2 cases, as well as the situation in Ukraine, and its disruption to health services, urging for strengthening of immunization and surveillance across Europe.  It also noted the recent detection of cVDPV type 3 in Israel in children, and in environmental samples in occupied Palestinian territories, and urged high-quality vaccination activities and strengthened surveillance.

Preparing for the post-certification era, the group underscored the importance of global cessation of all live, attenuated oral polio vaccine (OPV) use from routine immunization, planned one year after global certification of wild poliovirus eradication.  To ensure appropriate planning, coordination and implementation, the group endorsed the establishment of an ‘OPV Cessation Team’, to consist of wider-than-GPEI stakeholder participation and ensure leadership on all aspects of OPV cessation.

SAGE will continue to review available evidence and best practices on a broad range of GPEI-related programmatic interventions, including as relevant the increasing role of inactivated polio vaccine (IPV), including in outbreak response and effects of novel oral polio vaccine type 2 (nOPV2), as part of global efforts to secure a lasting world free of all forms of poliovirus.

After the safe and successful rollout of nationwide polio campaigns since November 2021, we have received tragic news that 8 health workers at the forefront have been killed this morning in a series of shootings in Takhar and Kunduz in northeast Afghanistan.  The vaccination campaign has been suspended in both provinces.

A statement has been issued by the Regional Director of WHO’s Eastern Mediterranean Region, Dr Ahmed Al-Mandhari, as well as by the United Nations in the country, condemning these attacks, expressing condolences to the families and underscoring that the provision of health and the safety of healthworkers at the forefront are paramount, and must be kept neutral to any geo-political situation anywhere.

Our thoughts and prayers are both with the families and our teams on the ground at this time.

Cairo, 10 February 2022 – The fourth meeting of the Regional Subcommittee on Polio Eradication and Outbreaks was convened on Wednesday 9 February, by WHO’s Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari. The meeting was attended by health ministers or their representatives from Djibouti, Egypt, the Islamic Republic of Iran, Pakistan, Qatar, Saudi Arabia, Sudan, United Arab Emirates and Yemen.

The Subcommittee declared the ongoing circulation of any strain of poliovirus in the Region to be a regional public health emergency and called on all authorities to enable uninterrupted access to the youngest and most vulnerable children through the resumption of house-to-house vaccination campaigns. It issued statements on wild poliovirus circulation in Afghanistan and Pakistan and on the circulation of vaccine-derived poliovirus strains in Yemen, where limits on house-to-house vaccination are preventing access to the most vulnerable children.

The spread of polio in the Eastern Mediterranean Region is a pressing emergency and it remains a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations (IHR 2005).

Members noted a sharp decrease in cases of wild poliovirus in Afghanistan and Pakistan in 2021 but warned against complacency.

“Wild poliovirus transmission is at a historic low in the endemic countries of Afghanistan and Pakistan. The progress is remarkable, but it is fragile. The opportunity to end polio is knocking at our door, and we must seize it,” said Dr Al-Mandhari.

Speaking to the progress made in the last year, the Special Assistant to the Prime Minister on Health, Dr Faisal Sultan, assured members that the programme in Pakistan was leaving no stone unturned in the pursuit of zero polio transmission.

“We have intensified efforts in the hardest districts and core reservoirs and we are closely monitoring transmission across the border in coordination with Afghanistan, taking measures to respond to outbreaks if they occur and making every effort to ensure that the virus doesn’t spill over in either direction. To boost the confidence of marginalized communities, we are also providing essential services and vaccination of other antigens and diseases,” he said.

Outbreaks of circulating vaccine-derived polioviruses type 1 (cVDPV1) and type 2 (cVDPV2) continued to emerge and spread in the Region in 2021. As of February 2022, Afghanistan, Djibouti, Egypt, Pakistan, Somalia, Sudan and Yemen are responding to transmission of vaccine-derived polioviruses.

“The increasing outbreaks of circulating vaccine-derived poliovirus type 2 in the Eastern Mediterranean Region and neighbouring countries of Africa are deeply concerning and must be stopped rapidly. To do so, we need to ensure that we are creating an enabling environment for health workers to reach children with those two drops of polio vaccine,” said newly nominated co-chair H.E. Dr Hanan Mohamed Al Kuwari, Minister of Public Health of Qatar.

During the meeting, Djibouti’s Public Health Minister, Dr Ahmed Robleh Abdilleh, shared plans for vaccination campaigns and increased surveillance in response to the transmission of cVDPV2, recently detected through the newly launched environmental sampling programme.

Reflecting on the work of the Subcommittee, co-chair and Minister of Health and Prevention of the United Arab Emirates H.E. Abdul Rahman Mohammed Al Owais urged members to sustain the commitment seen in in 2021.

“We have together advocated for an increase in domestic funds, we have driven collaborative public health action in our own countries, and collectively pushed for a regional response to address the regional public health emergency of the poliovirus. But these things alone will not end transmission,” he said.

Dr Al-Mandhari expressed appreciation for Egypt’s role as the first country in the Region to roll out a nationwide vaccination campaign using the novel poliovirus vaccine, and Chris Elias, Chair of the Polio Oversight Board, praised the remarkable progress made in polio eradication in Pakistan with support of the United Arab Emirate’s Pakistan Assistance Programme.

“This regional solidarity and commitment we have seen, through this Subcommittee, is something I am proud of. It is this commitment to the end goal that will help push us over the last mile,” said Dr Hamid Jafari, director of the regional polio programme and co-facilitator of the Regional Subcommittee.

Dr. Nida vaccinating a young boy. © Nida Ali

Dr Nida Ali joined the Polio Eradication Programme in her native Pakistan in 2017. A graduate of the medical faculty at Hamdard University in Karachi, she reflects on her time with the programme, the role of women and the eradication of polio in one of the last countries where it remains endemic.

I worked for the polio programme in Pakistan for four years and 10 months. It wasn’t easy – but then, what is? I look back at those long years and cry at the times when I laughed and laugh at the times when I cried. The programme gave me lot: exposure, experience, learning opportunities, knowledge, skills, and excellent colleagues from whom I learned a lot. But the ultimate gain was, of course, the children in my own country, including my son, who took polio drops in every polio immunization campaign.

I joined the programme in 2017, as Polio Emergency Response Officer in the provincial office in Punjab.  I’m originally from Rawalpindi and before joining the programme, I worked on a government-led Reproductive Health programme which sparked my interest in public health.

I’d read about polio as part of my paediatrics study at medical school but I didn’t see a case of polio until I joined the programme.  It was WPV (Wild Poliovirus Type 1) and it was in Punjab, a very small child who wasn’t even a year old. The second case I saw was a case I investigated when I was working as a Polio Eradication Officer in Islamabad. All the signs were there – the child lived in a very densely populated household where the hygiene conditions weren’t good, in a part of town where a lot of travellers were coming and going. He’d also been what we call a ‘refusal’, meaning that his caregivers had refused to allow him to be vaccinated. I examined the child and it was a classic case of Acute Flaccid Paralysis, or AFP, one of the signs that the virus may be circulating in the community. The ankle reflex was present but the knee reflex was lost. We sent samples to the laboratory and it was declared as a positive case of polio.

I held a number of roles during my time with the programme – Area Coordinator, Rapid Response Officer, Divisional Surveillance Officer – and I was fortunate enough to travel to other provinces. I went to northern KP (Khyber Pakhtunkhwa) to respond to a WPV outbreak, and to southern KP and Gilgit-Baltistan for post campaign monitoring. I learned some phrases of the local language in northern KP – how many children do you have in the house, the numbers from one to ten, how many children are vaccinated, can I see their finger mark – phrases that helped me make a connection with mothers and understand their responses. I also used to take out my phone and show them photos of my son – he was four years old at the time – and tell them that he takes the polio drops in every campaign. It was great to make such a human connection and I was able to convince many refusals that way.

Seeing the programme at field level gave me great insights but so did working at the National Emergency Operations Centre (EOC) in Islamabad. It’s where all the work and knowledge comes together, and where staff from all the different the provinces come so it was a great opportunity to meet them and exchange experiences.

Women make up around 40 percent of the polio programme but mainly as frontline workers who go from house to house to vaccinate millions of children across the country. There aren’t so many women at higher levels, often because women don’t apply for these positions, which is a shame. On many occasions I found myself to be the only woman in a large meeting room, particularly the meetings where policies and protocols are discussed. I think the presence of more women in leadership roles will bring an interesting perspective to the programme, particularly given our roles as mothers and caregivers.

Today I’m in Atlanta, studying Global Health at Emory University. It was my experience with the polio programme that helped me get through all the stages of obtaining scholarship and a placement in such a reputed University. This is an interesting opportunity of learning from the experts, which again, is not new to me as this is exactly what I’ve been doing at the polio programme in Pakistan. I’m not sure where this will lead me – back to polio or to another part of public health, I don’t yet know. All I know is that I will go where my expertise leads me.

I hope one day I can tell my son the story of how polio was eradicated and how no child will ever be paralyzed by this virus again. I hope by that time, we direct our resources for protecting children from other diseases or, even better, to curb the infections that have potential to lock the whole world down.

The Executive Board Room at WHO Headquarters during the 150th EB session. © WHO

January 2022, Geneva, Switzerland – As the world enters 2022, and with it the year when the new GPEI Strategy 2022-2026 – Delivering on a Promise – takes effect, global public health leaders at this week’s WHO Executive Board urged for intensified eradication efforts to capitalize on a unique epidemiological window of opportunity.  2021 saw the lowest ever levels of wild poliovirus cases in history, with five cases reported from the remaining two endemic countries, Pakistan and Afghanistan.  Cases of circulating vaccine-derived poliovirus have also declined compared to 2020.

Delegates attributed this favourable situation to sustained commitment from the highest levels in polio-affected areas, but issued severe warnings against complacency.  “2021 set the stage for success,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.  “We must now not lower our guard.”

“What is clear is that in 2022, we have a very real and realistically achievable opportunity to finish wild poliovirus from the world once and for all,” said Aidan O’Leary, Director of the Global Polio Eradication Initiative, WHO.  “But what is equally clear from the discussions at the Executive Board is that there is virtually no room for error now.  If we take our foot off the accelerator even by a little bit, this virus will come roaring back, and we will perhaps have lost the best chance yet for success.  The resounding message from this week’s meeting is this:  we cannot allow this to happen.  Success is the only acceptable outcome.”

Time and again, delegates, experts and partners such as Rotary International underscored the need to fully implement and finance the GPEI Strategy 2022-2026, highlighting that it clearly laid out the roadmap to achieving a lasting world free of all forms of polioviruses, through stronger community engagement, a renewed focus on gender equity and the rollout of new tools and technologies, including the novel oral polio vaccine type 2.

Delegates expressed appreciation at the polio programme’s ability to adapt to programmatic, epidemilogical and political developments, as demonstrated in Afghanistan last year, where – for the first time in more than three years – nationwide immunization campaigns resumed. At the same time, 2021 again saw the broader benefits of polio eradication, with health workers at the forefront supporting global COVID-19 response, vaccination and immunization recovery efforts, and the polio infrastructure now increasingly being integrated into broader public health systems in polio-free countries across the world. ​

With over 50 countries transitioning out of GPEI support in 2022, Member States also supported efforts to sustain the gains in polio-free countries, calling on WHO to continue its technical support in polio-free countries, and to ensure that polio assets, tools and expertise are effectively integrated into broader immunization, disease surveillance, primary health care, and outbreak preparedness and response efforts.

“Together with our partners at Rotary International, CDC, UNICEF the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance, we will continue to support Member States in their eradication efforts,” concluded O’Leary.  “But much is on the line.  We have everything in place – we need to focus now fully on optimizing our tools and tactics, and ensuring the resources to do so are available.  If those two things come together, we will be able to give the world one less infectious disease to worry about once and for all.”

Polio worker Soni Farhan has been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work. © Syed Mehdi Bukhari/WHO
Polio worker Soni Faisal has been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work. © Syed Mehdi Bukhari/WHO

Contracting the infectious virus at 11 months of age, few believed Soni would ever be able to work. Today, she’s a nominee for one of Pakistan’s most prestigious awards.

Soni started out in the programme in 1999, initially as a vaccinator. Now a mother of three children, these days, Soni works with the programme as a social mobilizer. Her role includes dispelling people’s misconceptions about the vaccine and engaging with parents about the importance of vaccinating their children.

When Soni received a notification from the Government of Pakistan that she had been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work, she didn’t quite know how she felt. “I’m not really interested in accolades, but my son and my husband were very excited” she said.

Soni says her work with the polio eradication programme has given her life meaning and purpose. “People would look at my leg and say, ‘How will she work?! She can’t work. But when I started working, then everyone could see, ‘yes, yes she can’,” she says.

“The polio programme has given me so much confidence. After I started working in polio, I had the confidence of meeting new people. Meeting family, going to weddings, all of it became easier. Before that, I had no confidence to even step out of the house,” she continues.

Soni recalls how hesitant her father was when she first told him she wanted to join the programme. “He was concerned I won’t be able to manage because of my health, but he understood very soon that this was something I just had to do. He told my mother ‘let her do it’.”

During her early training as a vaccinator, Soni recalls the words of one of her trainers – ‘If you can save one child from polio, then you would have served the purpose of your life’. “I knew, then, this was it, “she says. “This is what I had to do.”

The year Soni was diagnosed with polio – 1984 – nearly 200 other children in her neighbourhood of Liaquatabad in Karachi were also diagnosed with the virus. At the time, there were no door-to-door campaigns and children could only be vaccinated at health centres.

Today, Pakistan and Afghanistan are the last two countries in the world where wild poliovirus is endemic. In 2021, only one child was paralyzed by the virus in Pakistan and four in neighbouring Afghanistan. In 2020, a total of 84 cases were reported in Pakistan and 56 in Afghanistan.

The eldest of six siblings, Soni came from a very conservative family, where her grandmother would not let children leave the house. “In our family, all the children were born at home because the women were not allowed to leave the house, and so I was never taken to a health centre for vaccination.”

“My father always lived with the regret of not vaccinating his daughter,” she says. “Often parents make these decisions, and it is the child who has to suffer for all their life.”

Both Soni’s parents tried everything they could to heal her condition – visiting different doctors, acupuncture specialists, and anyone they could find who might offer any assurances. She also went through a very extensive operation, with steel bolts put in her leg resulting in excruciating pain that lasted for months.

“No matter what you do, whatever you try, there is no cure for polio,” she says. “I wanted to study sciences, and my teacher didn’t allow me to because she would say how will you stand in labs all day. I would go to college and one of the women in the bus would see me and say ‘Look at her, such a beautiful girl and look at what happened to her foot’.”

Soni says that when she is working on campaigns and some people see her, they immediately want to vaccinate their children, while others question why she is telling them to vaccinate while having polio herself.

“To them I say, I am here because I know exactly how hard it is if you are not vaccinated.”

In November:

  • No case of WPV1 was confirmed
  • 35 million children were vaccinated during the MR Campaign in November 2021.
  • 1 million children were vaccinated at 73 Permanent Transit Points

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Pakistan polio snapshot – November2021
Vaccination team crossing river in West Garo Hills of Meghalaya. ©WHO

With the ongoing COVID-19 pandemic, continued wild polio transmission in the remaining endemic countries and spreading outbreaks of circulating vaccine-derived polioviruses type 2 (cVDPV2), this year began with many challenges facing polio eradication efforts. But amid this new reality, countries and partners of the Global Polio Eradication Initiative (GPEI) intensified their efforts to protect children from lifelong paralysis.

In June, the GPEI launched the new GPEI Strategy 2022-2026, which lays out the roadmap to achieving a lasting world free of all forms of polioviruses through stronger community engagement, a renewed focus on gender equity and the rollout of new tools and technologies. These new tools include the novel oral polio vaccine type 2 (nOPV2), which began deployment under Emergency Use Listing (EUL) as part of the GPEI’s broader polio vaccine repository to curb cVDPV2 transmission. In August, the WHO African Region celebrated one year since it was certified wild polio-free, and countries recommitted to strong cVDPV2 outbreak response across the continent with the support of the GPEI.

Further critical progress took place in Afghanistan – one of two final countries endemic for wild poliovirus, along with Pakistan. For the first time in more than three years, nationwide polio immunization campaigns resumed across Afghanistan reaching 8.5 million children, including 2.4 million children who were previously inaccessible.

At the same time, polio programme health workers at the forefront continued to support global COVID-19 response efforts by delivering vaccines, mobilizing communities, and countering misinformation among other activities. The use of GPEI infrastructure for health emergency response has provided critical lessons for integrating polio resources into broader health systems as more countries work towards transition and the post-certification period.

Containment area monitoring in India. ©WHO

Following dire predictions issued at the end of 2020, the polio programme once again proved its ability to adapt to programmatic, epidemiological and political developments. Entering 2022, there is much cause for cautious optimism – wild poliovirus transmission has slowed drastically, and cases of cVDPV2 have also declined compared to last year.

Importantly, commitment to achieving a lasting polio-free world is evident at all levels: by core GPEI partners, including among the Polio Oversight Board, which travelled to Pakistan twice in 2021; by health workers, communities and parents; and by country leaders worldwide who helped champion this year’s milestones. With the new strategy, new tools and adapted approaches, the stage is set to achieve lasting success.

To stop all forms of polio for good, the GPEI aims to capitalize on the positive epidemiological situation leading into 2022. A key opportunity to kick-start the year will be the WHO Executive Board meeting in January, where Member States plan to discuss building on the successes of this past year by fully implementing and financing the programme’s new strategy. Rotary and other key global GPEI partners are planning a renewed and intensified outreach across the broader international development community to secure the necessary financial resources to achieve success. Polio immunization campaigns will also continue in full force in both endemic and outbreak countries.

Twelve months ago, the programme was in a much different place, as WHO and UNICEF launched an Emergency Call to Action to draw attention to the need for renewed commitment. A year later, thanks to a strengthened and unified response, the GPEI is meeting the moment and is more committed than ever to end all forms of poliovirus, once and for all.

WHO Regional Director, Dr Ahmed Al-Mandhari, observes polio vaccination in Karachi. ©WHO EMRO

In November, George Laryea-Adjei (Regional Director for South Asia, UNICEF) and Dr Ahmed Al-Mandhari ( WHO Regional Director for the Eastern Mediterranean ) joined fellow GPEI leaders on a visit to Pakistan. The regional directors met with government stakeholders and health workers, and commended Pakistan on its impressive progress interrupting poliovirus transmission. See why the regional directors emphasized that there is no room for complacency on the path to a polio-free Pakistan.  For more information please visit WHO Regional Office for the Eastern Mediterranean and UNICEF websites.

 

In October:

  • No case of WPV1 was confirmed
  • 3.53 million children were vaccinated during October 2021 in KP outbreak response.
  • 0.6 million children were vaccinated at 73 Permanent Transit Points

Downloads

Pakistan polio snapshot – October 2021

 

In September:

  • No case of WPV1 was confirmed
  • 41.5 million children were vaccinated during NIDs.
  • 0.8 million children were vaccinated at 72 Permanent Transit Points

Downloads

Pakistan polio snapshot – September 2021

 

In August:

  • No case of WPV1 was confirmed
  • 23.4 million children were vaccinated during sNIDs.
  • 1 million children were vaccinated at 121 Permanent Transit Points

Downloads

Pakistan polio snapshot – August 2021

The Health Ministers of the G20 countries, meeting in Rome, Italy, on 5-6 September 2021, recommitted to helping secure a lasting polio-free world once and for all.  In their official communiqué, the Health Ministers said:  “We re-affirm our commitment to eradicate polio… We note the critical role that adaptable surveillance capacity, like that found in the Global Polio Eradication Initiative, has in the ability to reach vulnerable communities to prevent and respond to pandemics.”

The importance to eradicate polio, and the GPEI’s unique value in supporting COVID-19 response efforts, had previously been underscored by other global fora, including at the recent WHO Regional Committee for Africa, the G7 Heads of State meeting, the G7 health ministers meeting and the World Health Assembly.

An integral part of the new GPEI Strategy 2022-2026 is to ensure close coordination with broader public health efforts, to not only achieve a lasting world free of all polioviruses, but also one where the polio infrastructure will continue to benefit other public health emergencies long after the disease has been eradicated.  Key to success, however, will be the continued support and engagement of the international development community, including by ensuring that previous pledges are fully and rapidly operationalized.

The GPEI also recognizes the critical role of women in the delivery of health services and has committed to ensuring their empowered engagement in polio eradication efforts in order to reach every last child.

©WHO Afghanistan/RaMin Afshar

25 August 2021 – “Poliovirus circulation does not stop during conflicts, it does not stop during emergencies. If anything, it makes children and families even more vulnerable by adding a layer of risk”, says a Polio Provincial Officer from Balkh province.

Despite risks and challenges due to the recent insecurity, the polio programme is staying and delivering for the children of Afghanistan. Our 315 staff and more than 70,000 polio health workers across the country remain firm in their resolve to eradicate polio. Their work ensures that critical polio activities continue while adapting to the rapidly changing situation and carry on even when hostility levels are high.

In 2021, one wild poliovirus type 1 (WPV1) and 43 circulating vaccine-derived poliovirus type 2 (cVDPV2) cases have been confirmed in Afghanistan. All cases have been reported in areas of the country that have for years been inaccessible for door-to-door vaccination campaigns, which left at least 3 million children repeatedly deprived of polio vaccination. Population displacement brought about by the current situation could further impact the programme’s access to children and increase immunity gaps against polio, triggering a rise in transmission. It is also feared that the mixing and movement of unvaccinated populations due to the upheaval faced by thousands of Afghans may spur polio transmission.

“We are working with all actors, to ensure there are no delays or disruptions to polio vaccination campaigns and overall routine immunization. Gains of the past twenty years cannot be lost. Children need immunization now, they must not bear the brunt of conflict and instability. We are calling for unimpeded access to all children,” says Dr. Dapeng Luo, WHO Representative in Afghanistan.

Pre-planning and resilience measures

While the current situation is a challenge, it is by no means the first the polio programme has faced. Using its wealth of knowledge from many years of operating in complex environments, the programme has invested in robust, pre-emptive contingency planning to be able to adapt and continue delivering. Regular monitoring of the security situation has allowed for nimble decision making.

The programme has moved swiftly to ensure safety and security of its staff. Its international staff footprint has been significantly reduced and vulnerable national staff and their dependants have been temporarily relocated to Kabul. Flexible working arrangements and salary advances have been provided to cover urgent needs of staff and polio health workers, who are the backbone of polio operations.

Around eighty percent of polio staff remain at their field locations and working to maintain essential polio services, supported remotely by colleagues who have needed to relocate.

“I am filled with pride for my team and their strong resolve, courage and passion. They are the heroes children of Afghanistan need right now. Thanks to their efforts, Acute Flaccid Paralysis (AFP) and environmental surveillance never stopped.  Except for a few locations that experienced temporary disruptions last week, stool sample collection, visits to active health facilities, case investigation, the shipment of samples to Pakistan for laboratory testing, and the collection and transport of sewage samples for polio environmental surveillance remain unaffected. COVID-19 surveillance, which the polio programme has been supporting since last year, has also continued,” says Irfan Elahi Akbar, Polio Team Leader, WHO Afghanistan.

©WHO EMRO

Vaccination continues

Polio vaccinations are continuing through permanent transit teams in most regions and at cross-border sites, including Friendship Gate (between Afghanistan and Pakistan).

After a brief pause, the National Emergency Operation Center is back up-and-running and undertaking planning needed to implement future campaigns. Discussions are ongoing with local authorities to safeguard the resumption of critical immunization activities across the country. The programme remains optimistic that polio vaccination campaigns planned for later this year can go ahead, however, is maintaining a flexible approach.

“The safety and security of staff and polio health workers is our top priority. Their commitment to ending polio is nothing short of inspirational. I stand ready to support their critical work in any way I can. I say this with absolute conviction: We will achieve a polio-free world,” said Dr. Hamid Jafari, Director of Polio Eradication, WHO Eastern Mediterranean Region.

See link to story on WHO EMRO’s website.

The Global Polio Eradication Initiative (GPEI) is closely monitoring developments in Afghanistan. GPEI partners and staff are currently assessing immediate disruptions to polio eradication efforts and the delivery of other essential health services, to ensure continuity of surveillance and immunization activities while prioritizing the safety and security of staff and frontline health workers in the country.

The polio programme in Afghanistan has operated for many years amid insecurity and conflict, and will continue working with all actors, agencies and organizations who enable delivery of immunization as well as deliver humanitarian assistance to populations in need across the country. The GPEI remains steadfastly committed to protecting all children from polio and supporting the provision of other essential immunizations and health services.

We strongly believe that the delivery of health care – including polio vaccination – is essential to prevent diseases and safeguard communities. Together with our partners, the people of Afghanistan, national and provincial authorities, we will do everything in our power to continue this critical work.

The Global Polio Eradication Initiative (GPEI) was deeply saddened by the UK parliament’s decision to support significant cuts to international aid, which will continue for at least five years. The cuts include a proposed 95% reduction in the contributions made to the GPEI by the UK for 2021. It is not clear whether this percentage reduction will apply in subsequent years but given the lower overall available funding, the GPEI will have to plan for significant funding cuts in the future.    

The UK pledged at the 2019 Reaching the Last Mile Conference in Abu Dhabi to help vaccinate more than 400 million children a year against polio. The GPEI already began incorporating those funds into its plans for global activities, and the process of implementing changes during the 2020-21 financial year will be deeply disruptive to the GPEI’s programmatic planning. The COVID-19 pandemic has left more children vulnerable to vaccine-preventable diseases such as polio and the impact of the cuts – now approved by parliament – will be profound.

The polio programme’s importance to global health security cannot be overstated. During the pandemic, the GPEI’s resources and expertise have been deployed extensively to assist the COVID-19 response. The unique value of the polio infrastructure was recently highlighted during the G7 meeting that took place in the UK when world leaders called for a global pandemic radar built on the existing surveillance networks of the polio and influenza programme.

That we are so close to a polio-free world is thanks in large part to longstanding UK leadership and investment. The GPEI looks forward to working with the UK and its other longstanding partners to protect progress and address the urgent issues that will arise from this shortfall in funding, and ultimately secure a world free of polio.

The funding will be used to vaccinate approximately 16 million children in 84 highest-risk districts. © UAE

The United Arab Emirates (UAE) on July 24 announced an additional US$9.5 million support to the Pakistan Polio Eradication Initiative (PEI). The funding will be used to vaccinate approximately 16 million children during door-to-door immunization campaigns in 84 highest-risk districts as well as an additional US$376,000 to provide personal protective equipment against COVID-19 for the frontline campaign workers.

The funding, which will be utilized from July to December, brings to more than US$23 million made available by the UAE in 2021. The Emirates, a long-time supporter of Pakistan’s polio programme and its main funder, has provided over US$200 million in financial support since 2014. Pakistan is one of two countries where wild poliovirus remains endemic.

Speaking on behalf of the Global Polio Eradication Initiative, Dr Palitha Mahipala, the World Health Organization Representative in Pakistan, thanked the UAE for its generous contribution, noting the UAE’s steadfast commitment not only to protecting children from lifelong paralysis but to the overall goal of polio eradication.

“The UAE has firmly stood by the polio programme with vital yearly contributions and in pleas for extra funding to address unforeseen challenges such as COVID-19,” he said. “This would not be possible without their support.”

Only one case of wild poliovirus has been reported in Pakistan in the first six months of the year, a significant decrease from the 59 cases reported during the same period in 2020. In order to be certified polio-free, Pakistan is required to report zero cases of wild poliovirus over a three-year period. The Government of Pakistan remains fully committed to reaching the goal of zero in the coming months.

The Emirates Polio Campaign plays an important role in driving eradication efforts at the frontline of Pakistan’s most vulnerable communities. © UAE

Through the Emirates Polio Campaign initiative, the UAE Pakistan Assistance Programme (UAE-PAP) plays an important role in driving eradication efforts at the frontline of Pakistan’s most vulnerable communities. In 2020, as part of the Emirates Polio Campaign, UAE-PAP support ensured close to 16 million children under five years of age received protection through repeated polio campaigns and all frontline workers in 84 districts received personal protective equipment and training to facilitate protection from COVID-19.

“The efforts and sacrifices of the field vaccination teams, who faced difficult field conditions and dangerous challenges, greatly contribute to the success of the campaigns and reducing the spread of poliovirus in the Islamic Republic of Pakistan,” said Mr. Abdullah Alghfeli, Director of the UAE-PAP.

Mr. Abdullah praised the humanitarian approach and the generous support of His Highness Sheikh Mohamed Bin Zayed Al Nahyan, Crown Prince of Abu Dhabi and Deputy Supreme Commander of the UAE Armed Forces, adding that His Highness’s humanitarian initiative to eradicate polio is a major factor contributing to the elimination of the disease.

Dr Shahzad Baig, National Coordinator of the National Emergency Operations Centre (NEOC) for polio eradication warmly welcomed the contribution as an important boost in ensuring the programme continued door-to-door polio campaigns, the most effective way of immunizing against the virus, and ending polio in Pakistan.

“We are getting closer to our goal but this is not the time to be complacent,” he warned. “We are re-doubling our efforts to ensure the gains of the past don’t slip away.”